ABSTRACT
The introduction and subsequent refinement of total hip replacement principles and techniques have enabled orthopaedic surgeons to provide relief to millions of patients worldwide. Several series have verified the long-term durability of this operation (1-4) with the original concept of a metal head and polyethylene liner as proposed by Chamley (5) currently accepted as the ‘‘gold standard.’’ These results, however, have also been accompanied by reports of both late and catastrophic, early failures related to localized bone loss and component loosening (Fig. 1). Initially felt to be due to ‘‘cement disease’’ (6), research into the etiology of aseptic failure has identified particulate wear debris as the primary cause of osteolysis (7,8). The generation of particulate debris, particularly ultra high molecular weight polyethylene (UHMWPE), is the common weak link among early hip implants and the majority of prostheses currently in use throughout the world. The ensuing inflammatory destruction of bone support and eventual implant loosening represent one of the major limitations to the long-term survival of total hip replacements (9). As hip arthroplasty is now being performed in a younger population of patients, alternatives to the conventional metal/polyethylene articulation are being sought that would minimize the creation of particulate debris.
